Workers' Compensation
Like other states, the North Carolina workers’ compensation program is a system set up by the government to provide financial assistance to employees who are injured or become ill while in the course and scope of their employment.
The North Carolina Industrial Commission administers the system.
If you are an employee in North Carolina and are injured while working or become ill due to your job, you may be eligible for workers’ compensation benefits.
Understandably, you might not know how to file a workers’ compensation claim. If you have questions on the workers’ comp claim process, we are here to answer your questions.
7 Steps for Filing Your Workers’ Comp Claim
Let’s go over some general information regarding the steps for filing your claim.
Step 1: Report Your Injuries or Illness to Your Employer
If your injuries are not life-threatening, the first step is to report your injury or illness to your immediate supervisor and any other person responsible for workers’ comp claims at your job.
You should do this as soon as possible, but no later than 30 days after the injury or illness.
Step 2: Seek Medical Treatment
After reporting the injury or illness to your employer, you should seek medical treatment. If your injuries are severe, your first step might be to seek medical treatment and then report the injury.
Your health and safety should always be the top priority.
In North Carolina, you don’t necessarily have the right to choose your own treating physician.
Current law in North Carolina says employers shall provide medical treatment, which means your employer or the workers’ compensation insurance company can choose which doctor you see.
Step 3: Complete the Employer’s Report of Injury or Illness (Form 18)
You must follow workers’ compensation procedures by filing the Notice of Accident to Employer and Claim of Employee, Representative, or Dependent (Form 18) within two years of the date of injury or illness.
Otherwise, the Industrial Commission might bar you from recovery. You should complete this form and send it to the North Carolina Industrial Commission.
This form includes information such as your name, the date of the injury or illness, the specific injury or illness, and the date you were able to return to work.
You should keep a copy for your records and submit one to your employer.
Your employer might need to file Form 19, the first report of injury (FROI). Employers must submit Form 19 if you miss more than one day of work because of your workplace injury or if your medical bills exceed $4,000.
Step 4: Wait for a Decision
After you file a Form 18, your employer and its insurance company legally have up to 30 days to accept or deny your claim.
However, insurance companies often take longer than 30 days to make a decision on compensability.
If your claim is denied, you can appeal the denial by filing a Form 33 Request that Claim be Assigned for Hearing.
Step 5: Attend Mediation
After Form 33 is filed, your claim will not immediately proceed to a hearing. Instead, the Industrial Commission will refer the case to mediation if you are represented by an attorney.
The parties will have the opportunity to explore a settlement to your case at mediation.
Your attorney will present your case to the mediator and opposing counsel and work to obtain the best financial recovery possible for you at mediation.
Step 6: Attend a Hearing (If Needed)
If your case does not settle at mediation, it will proceed to hearing. Your hearing will be before an administrative judge called a Deputy Commissioner.
You will need to wait for a decision from the Deputy Commissioner. The decision will be based on the hearing testimony, medical records, and deposition testimony from medical experts.
The Deputy Commissioner will approve or deny your benefits claim. Or the Deputy Commissioner may award you some benefits but deny your request for other benefits.
It can take anywhere from six months to one year to receive a decision from the Deputy Commissioner.
Step 7: File an Appeal
If the Industrial Commission denies your claim, you can appeal your case to the Full Commission. You will need to file an appeal with the North Carolina Industrial Commission, which can be complicated.
If you have questions on how to file a workers’ comp claim appeal, please speak with a lawyer at Mehta & McConnell, PLLC.
What to Know About North Carolina Workers’ Comp Appeals
It’s crucial to follow all the requirements for filing an appeal. Otherwise, you might not be entitled to proceed.
For example, there are strict deadlines when appealing a decision to the Full Commission. Your appeal before the Full Commission will be in front of three Commissioners.
Only the attorneys will argue the appeal. It may take the Full Commission one year to issue its decision after the attorneys make oral arguments.
If you still disagree with the Full Commission’s decision, your next step is to pursue an appeal through the North Carolina Court of Appeals and possibly the North Carolina Supreme Court.
Tips for Improving Your Chances of Approval on Appeal
Hiring an attorney helps to ensure everything is filed correctly and on time. But if your claim is denied, it becomes crucial to hire an experienced North Carolina workers’ comp attorney.
Filing an appeal is a specialized process that only trained professionals fully understand. Your workers’ comp attorney will also represent you at the mediation of your claim prior to hearing.
Your attorney may be able to help you negotiate a favorable resolution, thereby avoiding the stress and uncertainty of going to a hearing where one side often loses and the other side wins.
Other things to do when your workers’ comp claim is denied include the following:
- Make sure your employer and insurance company filed all appropriate forms;
- Give your insurance company additional information that might be helpful, such as witness names and medical reports;
- Document all evidence and keep records of everything that might be helpful;
- Make sure to follow all medical instructions regarding work and activity restrictions;
- Don’t miss any follow-up appointments;
- Be sure to let your doctors know if you experience new symptoms or develop side effects from any medications; and
- Keep your contact information updated with work and the Industrial Commission.
There are multiple steps to take in the event your claim is denied. Don’t delay filing an appeal, or you might lose your right to pursue workers’ compensation benefits.
Contact a North Carolina Workers’ Compensation Lawyer
It is essential to report the injury or illness to your employer right away, seek medical treatment, and complete the required forms correctly.
If you need to file a workers’ compensation claim or appeal in North Carolina, contact Mehta & McConnell, PLLC.
Our North Carolina workers’ compensation lawyers have decades of experience assisting injured workers to get the benefits they deserve.
Schedule a consultation today to learn more about your rights and how we can help you.
Viral Mehta
Viral Mehta is the managing attorney of Mehta & McConnell Injury Lawyers, a Charlotte, North Carolina Workers’ Compensation law firm. He enjoys spending time with friends and family, traveling, sports, and reading.
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